Healthcare Provider Details

I. General information

NPI: 1508267378
Provider Name (Legal Business Name): RAFAEL BADALOV PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6409 110TH ST
FOREST HILLS NY
11375-1413
US

IV. Provider business mailing address

6409 110TH ST
FOREST HILLS NY
11375-1413
US

V. Phone/Fax

Practice location:
  • Phone: 718-915-3741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: